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I am a new graduate RN living in North Carolina. I float throughout the entire hospital (medical, surgical, oncology, ICU, and ED) at night.

NCRNMDM's Latest Activity


    Giving an awesome verbal report?

    Every nurse has his/her own way of giving report, and you will develop your own way over time. Personally, for me, I want the important details, vitals, lab values, etc. I don't want a five day history of the patient if those details don't pertain to my shift tonight. I generally move in a head-to-toe fashion (or try to at least). My report goes like this: Brief introduction (patient's name, DOB, Dx, allergies, etc) Mental status and orientation (I also mention any psych history here if it pertains to the care that will be given) Oxygenation, breath sounds, sats, etc. Heart sounds, heart rate and rhythm, telemetry, capillary refill, etc (anything to do with circulation and perfusion). Bowel sounds (NG tube is also included here if present). IV access (and anything that is currently infusing). Urinary continence and system (Foley, urinary output for the shift, etc). Bowel continence (number of stools, etc). Integumentary system (skin condition, any wounds, any surgical incisions, edema, bruising, etc) Surgical drains (if present, how much they've drained, consistency, etc) Pain management (last dose of pain meds, location of pain, characteristics, etc). Scheduled meds (and when they are due next). Abnormal lab results, and labs that need to be drawn during the shift. Any tests that the patient might be going down for during the shift. Final details if there are any.

    How do you draw up meds for IVP?

    I draw the dosage of the medication up (in this case 0.4 ml), and then squirt enough NS out of a flush to fit that dose of medication into the flush. In this case, I would squirt out less than 1 ml of a 10 ml syringe of NS. I completed my preceptorship in a trauma center/ED, and I was always taught that you stopped all IV fluids when giving a push, so as not to bolus the patient. When I administer the medication, I stop the IV fluids, give my med mixed with NS, and then flush with a 10 ml NS flush. After that, I turn the IV fluids back on at the rate they were infusing at.
  3. This patient's WBC count is high. If you didn't recognize that, go look it up. What does a high white count indicate? If you said infection, you'd be correct. It would appear to me that this patient has an infection of some sort, and the Flagyl is being used to treat the infection.

    How are your grades posted?

    Anything below an 80 in my program is failing. If you make an 89.9, it's just that. There is no rounding up or down.

    Case Study Help

    Since this is peritoneal dialysis we are talking about, and the return is cloudy, I'm going to say that the cause could be possible peritonitis. Also, with the ammonia level as high as it is, is it possible that some of the confusion and hallucinations are related to this? As for the dropping sat, the first thing I think of in an immobilized and otherwise unhealthy patient is PE. This doesn't do much to explain the irregular heart beat, though. I think a D-Dimer may be in order for this patient, to rule out or confirm some type of embolism. That's just my two cents, feel free to correct me if I'm wrong. I'm here to learn just like everyone else.

    Questions about Mental Health.

    Our mental health was a 10 week summer unit combined with advanced med-surg. We did six weeks of mental health, five weeks of mental health clinicals, and four weeks of advanced med-surg in class. The mental health portion was by far the easiest thing I've done in nursing school, and I graduate in about 8 months. You really don't have anything to worry about.

    Anyone have a list of Nursing Fundamental Skills?

    I'm about to start fourth semester. We learned nearly all our skills during first semester. We covered IVs, Foleys, NGs, dressing changes, bladder irrigation, suctioning, IV meds, IM and subcutaneous injections, oxygen therapy modalities, surgical drains and their operation, eye irrigation and administration of eye drops, head to toe assessments, stoma assessments and colostomy care, and a few other things. We're about to start OB and L&D, and we have another set of skills specific to that class to learn. Other than that, we covered pretty much everything first semester.

    Clinical rotation in the PACU?

    You're so lucky! I spent two semesters on a surgical floor, and I just finished a semester of mental health. I'm approaching fourth semester, and will be doing an OB/neonatal nursery clinical, and another clinical on a surgical floor. I got to do a one day out-rotation in the PACU, and I loved it. Don't get me wrong, I've learned a lot on the surgical floor (my floor also did medical overflow and ICU step-down), but I'm tired of it. I wish I could do one clinical where I actually got to do procedures. Over the course of three semesters, I've started two IVs. I've never put in an NG or a Foley, and I've never taken an NG out. I've done tons of dressing changes, and I've emptied all kinds of drains, but my clinicals have been severely lacking in the way of nursing skills. Be glad that you are in PACU where you will have the chance to practice your skills and learn in a fast-paced environment. It's a really wonderful place to work, in my opinion.

    Nausea, loose runny stools, or dizzines???

    I'm about to be a fourth semester student, and I will graduate in May. As soon as I read the question, I immediately selected loose runny stools because this can be a sign of C. Diff (an adverse effect of antibiotic therapy). You will get better at these type of questions as you progress through the program, but it will take time.

    How far do you drive for nursing school?

    There are three schools in our nursing program, and a number of clinical facilities. I currently drive 1 hour and five minutes one way to class, and 1 hour and 30 minutes one way to clinical. Class is on Monday from 1600-2100, and clinical is Saturday and Sunday from 0745-1800. Next semester, I will (more than likely) be driving 30 minutes one way to one class, 20 minutes one way to another class, and 35 minutes one way to clinical. I will have one night shift clinical, one day shift clinical, and class two days a week from 1500-1800 (that's the schedule now, that may change). If the schedule does change, I will be making the 1 hour and 30 minute one-way drive back to my current clinical facility.
  11. You will be nervous, to one degree or another, until you graduate nursing school. First, you'll be nervous about the program and your newness. Next, you'll be nervous about the overwhelming amount of work. After you've gotten used to all that, you'll be nervous about exams, finals, clinicals, care plans, concept maps, pharmacology, pathophysiology, studying, and everything else in the world. The day you pass your NCLEX, you will be nervous about your first day as an RN. You probably won't stop being nervous until you've been an RN for at least six months. I'm about to be a second year student, and I graduate in less than a year, and I'm still nervous about some things.

    Worried to death about dosage cal!

    Our instructors didn't teach us dosage calculations, or medical math. Instead, we had to teach ourselves. There were a few who struggled (and failed out), and a few who still struggle, but we've done pretty well. I always hated math too, but, for some reason, medical math just comes to me. It isn't really all that hard.

    Interview for a Patient Care Assistant PT SVCS

    I'm a third semester nursing student, and I just got a CNA II job on a med-surg oncology/transfusion unit last week (this unit also does outpatient chemo infusions, blood transfusions, ICU step-down, intermediate care, telemetry, and hospice and palliative care). I had never interviewed for a position, and I was really nervous, as you are. I submitted a resume with my online application, but I also brought a copy with me just in case they needed it. I didn't take anything else (besides a pen). The unit I got hired on does peer reviews. This means that you spend about 15 minutes with the hiring manager initially, then you are turned over to the RNs and CNAs on the unit. You go for a tour of the unit, and then one RN and one CNA interviews you. They have a list of like 50 questions they can choose from, so you never know what you're going to be asked. I heard things like, "why do you want to work here?" "Why should we hire you?" "How will you handle going to school full time and working at least 24 hours a week?" "How much experience do you have with prioritizing care?" "Tell me about a time when you went above and beyond a patient's requests." "What made you want to work on this unit?" "Why do you want to be a nurse?" "Tell me about your previous experiences." "Describe yourself." "What are some of your best qualities?" The interview went really well, and I was offered the job 30 minutes after the interview ended. The people who interviewed me were incredibly nice, and they did everything they could to calm my nerves. It was a formal interview, but it felt really friendly and personal. I asked questions like, "what's the work environment like in this unit?" "What is your nurse/patient and CNA/patient ratio?" "Do the members of this unit work well together as a team?" "Are you happy and satisfied working on this unit?" "What is your typical census here?" Good luck, and stay calm. The interview won't be nearly as bad as you think it will!
  14. What they did to you wasn't fair, but you do have to be extremely precise with BP readings. I agree that they shouldn't have waited twenty minutes, but work with me for the purpose of making my point. Let's say that the 8 point difference was actually correct and had nothing to do with the time period (something I highly doubt). In the real world, most patients don't have a perfect, loud, and clear BP. They are in the hospital for a reason, and their BPs are often difficult to hear or abnormal. While an 8 point difference on a healthy classmate doesn't seem like a big deal, an 8, 10, or 12 point difference on an acutely ill patient is a big thing. There's a huge difference in obtaining a BP of 94/60 versus a BP of 82/48. With the first pressure, the MAP (mean arterial pressure) is 71.3 (the low side of normal). With the second pressure, the MAP is 59.3 (way too low). I agree that what they did wasn't fair, and I am glad you got in somewhere else. If you don't feel comfortable and confident with BPs, practice them. I used to hate them, but I've gotten a lot better. Good luck with your nursing school career!

    CNA salary

    NC CNA II in medical-surgical oncology/transfusion unit. No CNA experience, but I am a third semester nursing student. I will be working second shift (1400-2200) with the possibility of floating to third (2200-0600) or first (0600-1400). My starting salary will be $9.54/hr with a $0.75-$1.00 extra per hour. After three months, my salary will increase to $9.89/hr with the differential. If I cover a shift I don't normally work, third or first, I will get an extra $4.00/hr. With my differential, I will be making anywhere from $10.29-$10.54/hr for the first three months. After that, I will be making anywhere from $10.64-$10.89/hr. I will be working anywhere from 24-32 hours per week, so that's $11,854.08 per year at $10.29/hr and $12,257.28 per year at $10.64/her (using 24 hours per week).